"Gary Letizia Pre-Hospital Blood Transfusion Act"; authorizes advanced life support providers, under medical oversight, to administer blood products to patients in pre-hospital settings, and establishes certain reimbursement for such providers.

S4347

SENATE, No. 4347

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MAY 28, 2026

Sponsored by:

Senator� KRISTIN M. CORRADO

District 40 (Bergen, Essex and Passaic)

SYNOPSIS

���� �Gary Letizia Pre-Hospital Blood Transfusion Act�;
authorizes advanced life support providers, under medical oversight, to
administer blood products to patients in pre-hospital settings, and establishes
certain reimbursement for such providers.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning pre-hospital blood transfusions by advanced
life support providers, designated as the �Gary Letizia Pre-Hospital Blood
Transfusion Act,� and supplementing various parts of the statutory law.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� The Legislature finds
and declares that:

���� a.���� Uncontrolled hemorrhage
is a leading cause of preventable death in trauma patients, and timely
administration of blood products significantly improves survival rates.

���� b.��� In the United States,
postpartum hemorrhage affects approximately three to five percent of obstetric
patients and is a leading cause of maternal mortality.

���� c.���� The expansion of blood
administration by advanced life support providers, under appropriate medical
oversight, is necessary to improve the pre-hospital care of acute blood loss
and to save lives in New Jersey.

���� 2.��� As used in this act:

���� �Advanced life support agency�
means an entity licensed to provide pre-hospital emergency advanced life
support services in the State of New Jersey.

���� �Advanced life support
provider� means a person who is certified by the Commissioner of Health to
provide advanced life support services in the State, including, but not limited
to, paramedics, mobile intensive care nurses, or other appropriately credentialed
clinicians as authorized by the Department of Health.

���� �Blood product� means any
therapeutic substance prepared from human blood, including whole blood, blood
components, and plasma derivatives.

���� �Carrier� means an insurance
company, health service corporation, hospital service corporation, medical
service corporation or health maintenance organization authorized to issue
health benefits plans in this State.

���� �Covered person� means a
person on whose behalf a carrier offering the plan is obligated to pay benefits
or provide services pursuant to the health benefits plan.

���� �Department of Health� means
the New Jersey Department of Health.�

���� �Health benefits plan� means a
benefits plan which pays or provides hospital and medical expense benefits for
covered services, and is delivered or issued for delivery in this State by or
through a carrier.

���� �Low-titer O whole blood�
means blood that is universally transferrable and recommended for emergency use
in pre-hospital settings.

���� �Medical oversight� means the
supervision of advanced life support providers by a licensed physician trained
in trauma or emergency care.

���� 3.��� a. An advanced life
support agency seeking to administer blood products shall:

���� (1)�� notify the Department of
Health at least 60 days in advance of intent to begin a blood transfusion
program;

���� (2)�� designate a blood bank
medical director to serve as the medical director of the blood transfusion
program.� If the blood products are sourced from a hospital-based blood bank,
the hospital�s blood bank medical director shall retain ultimate authority over
the storage, handling, and medical appropriateness of blood product use.� The
blood bank medical director may delegate responsibilities related to
pre-hospital operations, such as protocol development and oversight of
training, to the emergency medical services director; however, the blood bank
medical director shall retain ultimate authority over the program;

���� (3)�� only utilize advanced
life support providers who have completed a blood administration course that
has been approved by the Department of Health;

���� (4)�� ensure the presence of
at least two trained advanced life support providers during the administration
of blood products; and

���� (5)�� maintain proper blood
storage and warming equipment, including transport coolers.� All blood product
storage, warming, and other equipment shall be those approved by the federal
Food and Drug Administration (FDA), if applicable.

���� b.��� Blood products shall be
stored using any anticoagulant preservative solutions approved by the FDA, or
Department of Health, when applicable.� Such solutions may include CPDA-1
(citrate phosphate dextrose adenine-1), CPD (citrate phosphate dextrose), or other
anticoagulants that provide varying shelf lives and preparation compatibility,
including spinning down into packed red blood cells (PRBCs).� The Department of
Health shall consider factors such as shelf life, ability to prepare PRBCs, and
waste minimization in its approvals.� Blood products shall be transported and
administered in accordance with:

���� (1)�� regulations on blood,
and storage and handling promulgated by the FDA;

���� (2)�� American Association of
Blood Banks standards; and

���� (3)�� any applicable
guidelines issued by the Department of Health.

���� c.���� Participating advanced
life support providers shall:

���� (1)�� conduct quarterly audits
of pre-hospital blood transfusions;

���� (2)�� submit reports to the
Department of Health in accordance with the reporting cadences already required
under applicable standards, including daily clinical documentation to the
Office of Emergency Medical Services; and

���� (3)�� implement protocols for
recognizing and managing transfusion reactions.

���� 4.��� a. Advanced life support
providers, under medical oversight, shall be authorized to administer a blood
product to a patient in a pre-hospital setting if:

���� (1)�� the patient exhibits
signs and symptoms consistent with current clinical practice requiring
administration of blood products;

���� (2)�� the advanced life
support provider has completed a blood administration training program that has
been approved by the Department of Health; and

���� (3)�� the administration
follows established protocols approved by the Department of Health.

���� b.��� An advanced life support
provider shall not be required to obtain on-scene physician approval prior to
administration but shall notify the receiving trauma or emergency center upon
initiating a transfusion.

���� c.���� Advanced life support
providers shall obtain informed consent, when feasible, from the patient or the
patient�s legal representative prior to administering a blood product.� In
emergency situations where the patient is unconscious or otherwise incapable of
providing consent, administration may proceed under the doctrine of implied
consent, consistent with State and federal emergency care guidelines.

���� 5.��� The Department of Health
shall establish a grant program in order to assist participating advanced life
support agencies with the initial costs of implementation, including, but not
limited to:� blood storage and transportation equipment; blood warming and
infusion devices; and training and certification costs.

���� 6.��� a. The NJ FamilyCare and
Medicaid programs shall provide coverage for pre-hospital blood transfusion
services delivered to a covered person on the same basis as when blood
transfusion services are delivered within the facilities of a hospital, in
accordance with the Centers for Medicare and Medicaid Services Advanced Life
Support Level 2 billing code.

���� b.��� Any reimbursement rate
for the blood transfusion program under this section shall be established
pursuant to the guidelines for Medicaid and Medicare reimbursement,
particularly for the cost of blood products, storage, and administration.

���� 7.��� A carrier that offers a
health benefits plan in this State shall provide coverage for pre-hospital
blood transfusion services delivered to a covered person on the same basis as
when blood transfusion services are delivered within the facilities of a hospital,
in accordance with private insurance billing policies that are aligned with
federal reimbursement standards.

���� 8.��� The Department of Health
shall work with blood banks and hospitals to ensure adequate availability of
low-titer O whole blood and other blood products for advanced life support
provider use.

���� 9.��� a. All participating air
medical services and mobile intensive care programs shall implement a defined
stewardship program to prevent waste through the responsible handling and
storage of whole blood and blood components.� This system shall ensure that:

���� (1)�� blood products stored by
advanced life support agencies are tracked in real time;

���� (2)�� blood products stored by
advanced life support agencies are regularly rotated with hospital blood banks;

���� (3)�� advanced life support
agencies transfer any blood products that are approaching expiration to a
designated partner hospital.� Blood return timelines may be determined by the
EMS agency in collaboration with the partner hospital, as permitted under
applicable law, provided the blood is returned with sufficient lead time for
clinical use or reprocessing; and

���� (4)�� partner hospitals
incorporate the received units into the active transfusion inventory of the
hospital.

���� b.��� The Department of Health
shall develop standardized protocols and digital inventory coordination systems
to support efficient, compliant, and transparent blood product exchange between
advanced life support agencies and hospitals, including the return and
restocking of coolers and supplies, as needed.� Blood rotation logistics shall
prioritize minimizing waste and maximizing clinical utility while maintaining
chain of custody and temperature control throughout the process.

���� 10.� The Commissioner of Human
Services shall apply for any State plan amendments or waivers as may be
necessary to implement the provisions of this act and to secure federal
financial participation for State Medicaid expenditures under the federal
Medicaid program.

���� 11.� The Commissioner of
Health, in consultation with the State Office of Emergency Medical Services,
and within 180 days following the date of enactment of this act, shall develop
and adopt rules and regulations, pursuant to the �Administrative Procedure Act,�
P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the
provisions of this act.

���� 12.� This act shall take
effect on the first day of the seventh month following enactment, except that
the Commissioners of Health and Human Services may take any anticipatory
administrative action in advance as may be necessary for the implementation of
this act.

STATEMENT

���� This bill, to be known as the
�Gary Letizia Pre-Hospital Blood Transfusion Act,� would allow advanced life
support providers to establish a blood transfusion program.� An advanced life
provider would have to notify the Department of Health (department) at least 60
days in advance of its intent to begin such a program.� The advanced life
support provider, in establishing the program, would need to:

�

designate a
blood bank medical director as the medical director of the blood transfusion
program, who may delegate responsibilities related to emergency medical
services (EMS) to an EMS director;

�

utilize only
advanced life support providers who have completed a blood administration
course approved by the department;

�

ensure the
presence of at least two trained advanced life support providers during the
administration of blood products; and

�

maintain proper
blood storage and warming equipment, including transport coolers.� All blood
product storage, warming and other equipment must be those approved by the
federal Food and Drug Administration, if applicable.

���� Additionally, the advanced
life support provider would need to:

�

conduct
quarterly audits of pre-hospital blood transfusions;

�

submit reports
to the department in accordance with the existing daily, monthly, quarterly,
and annual cadence of clinical, equipment, and quality reporting standards
already in practice; and

�

implement
protocols for recognizing and managing transfusion reactions.

���� Once the program is
established, a licensed advanced life support provider would be authorized,
with medical oversight, to administer blood products to a patient in a
pre-hospital setting under certain conditions.� Reimbursement rates for
pre-hospital blood transfusions would be at rates equivalent to hospital-based
transfusions.

���� Additionally, the department
would establish a grant program to assist advanced life support providers with
the initial cost of implementation of the blood transfusion program.� The
department would work with blood banks and hospitals to ensure an adequate
supply of low-titer O whole blood is available for advanced life support
provider use.� Additionally, the department would develop a Statewide blood
rotation system to prevent the expiration and waste of blood products.

���� The �Gary Letizia Pre-Hospital
Blood Transfusion Act� is named in honor of Gary Letizia, whose life was
extended by timely blood transfusions.� His family�s enduring commitment to
raising awareness about the life-saving power of transfusion in partnership
with first responders continues to inspire this vital initiative.